Cortical superficial siderosis is reflective of linear hemoglobin breakdown products over the superficial layers of the cerebral cortex or subarachnoid spaces.

Increasing age, pre-existing dementia, a history of intracerebral hemorrhage (ICH), ICH lobar location, severe white matter hyperintensities score, and an absence of lacune are independent clinical and radiologic markers associated with cortical superficial siderosis (cSS) and underlying cerebral amyloid angiopathy in patients with spontaneous ICH, according to the findings of a prospective observational study published in Neurology.1

Consecutive patients with parenchymal hemorrhage and spontaneous ICH from the observational Prognosis of IntraCerebral Haemorrhage (PITCH) study (n=258) were recruited.2 At baseline, the investigators prospectively obtained data on the presence of vascular risk factors, including whether the patients had a history of stroke or transient ischemic attack (TIA), ischemic heart disease, or atrial fibrillation. The Informant Questionnaire on Cognitive Decline in the Elderly, with a score of >64 defining pre-existing dementia, was used to obtain information on baseline cognitive function. Patients were invited to participant in an in-person or telephone-based follow-up at 6 and 12 months.

Limitations of the study include the underestimation of both the prevalence of baseline cSS and the number of ICH recurrences in survivors of ICH due to the exclusion of patients who died prior to discharge, as well as the focus on clinical events only.

The independent markers associated with cSS in this cohort “may provide additional information on ICH recurrence risk assessment with relevance for clinical practice and management of ICH survivors.”